NPIMap

Organization Active NPI

Mary Black Health System LLC

Doing business as Foothills Family Medicine

  • Family Medicine Physician
  • Pacolet, SC
National Provider Identifier
1629090568
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARY BLACK HEALTH SYSTEM LLC
Doing business as
Foothills Family Medicine
Practice address
391 Glenn Springs Rd
Pacolet, SC 29372-2417
Phone
(864) 474-3013
NPI assigned
Jul 23, 2006
Last updated
Aug 22, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY BLACK HEALTH SYSTEM LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debbie Brewer
Title
Director of Provider Enrollment
Phone
(615) 465-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

391 Glenn Springs Rd
Pacolet, SC 29372-2417

Mailing address

391 Glenn Springs Rd
Pacolet, SC 29372-2417
Phone (864) 474-3013

Other identifiers 1

IdentifierTypeStateIssuer
GP1607MedicaidSC

Other names 1

  • Foothills Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Spartanburg Surgical CL21 organizations share this tax ID, including this one
Part of
Spartanburg Surgical CL

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

391 Glenn Springs Rd
Pacolet, SC 29372
Phone (864) 474-3013

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1629090568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 GLENN SPRINGS RD",
            "city": "PACOLET",
            "state": "SC",
            "postal_code": "293722417",
            "telephone_number": "864-474-3013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 GLENN SPRINGS RD",
            "city": "PACOLET",
            "state": "SC",
            "postal_code": "293722417",
            "telephone_number": "864-474-3013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK HEALTH SYSTEM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK HEALTH SYSTEM LLC",
        "enumeration_date": "2006-07-23",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1607",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothills Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pacolet, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.